Writing (mostly) about disruptive trends and technologies in the 21st century

Wednesday, March 18, 2015

Web Secret #354: clueless about confidentiality

The other day, I logged into Facebook, and I came across the following fully public post and comments (all names and identifying information have been changed):

First, the post - Abby writes: "Hi Bob, do you accept Aetna insurance?" (Note: Abby's full name and photo are posted.)

First comment, posted by Bob the psychotherapist:"Hi Abby. Can you send me a copy of your insurance card? What about using your EAP benefit? I'm affiliated with a number of Employee Assistance Programs. I would be happy to work with you. "

2nd comment, a response from Abby:"The Acme Widget Company has an EAP. I have a counselor assigned to me. He wants me to see you due to our previous work together. He says I need more help with my issues than can be offered through the EAP. Do you know Dr. Phil in Oak Grove, IL? He is my new psychiatrist."

First of all, Abby, do not, EVER, I repeat EVER, write public posts in which you reveal:

1. that you have a mental illness (or appear to have one)
2. that you are seeing a psychiatrist
3. the name of your insurance plan
4. that you are seeing an EAP counselor
5. that you want to see Bob for counseling.

We do not live in a world of little ponies, unicorns and butterflies. And the information that you made public can be used against you. For example, someone at Acme sees this post and circulates it around the company. You don't get that sought after promotion, because your boss read your post and decided you are too unstable for the promotion. Or you apply for a job, and your prospective employers look for you on Facebook (and trust me, most will,) and they don't hire you, because, why take a chance that your attendance and job performance may be affected by your mental illness?

And Bob, you should never, EVER, respond to an inappropriate client post in a public Facebook setting. You violated this clueless client's confidentiality.

The irony is that I am absolutely positive that if Abby's employer called you at your office, and asked "Are you seeing Abby for counseling?" you would respond, as we have all been taught, "I can neither confirm nor deny that I am seeing Abby for counseling."

But on Facebook? You seem to have lost your bearings.

And you are not the only clinician who has. In a previous post, I wrote about studies showing that therapists do not understand the confidentiality issues raised by social media. I also presented some best practices to avoid breaking confidentiality on the web. I reiterate them here:

1. Overall, it is important for clinicians to recognize that their "private" online activity may intersect with their professional competence. Indeed, online self-disclosures may represent the intersection where dilemmas surrounding personal and professional roles meet - in some cases signaling the start of boundary violations.

2. Self-disclosure online is almost inevitable. Often it is initiated by clients who want to learn more about their therapists. Some clients may do more than a Google search: They may join social networking sites, join professional listservs/chat rooms, or pay for online background checks or online firms to conduct illegal, invasive searches.

3. Practitioners need to create and maintain a formal social networking site policy as part of the informed consent process. Informed consent processes should at the very least acknowledge the risks and benefits of using social media and other technology. In addition, such policies should lay out psychologists' expectations for using such sites, namely that practitioners do not "friend" or interact with clients on social networking sites.

4. Therapists should develop online technological competence - they must understand the nature and requisite technology of social networking sites. They should proactively set controls that limit who sees their personal information.

5. Clinicians should contact both their professional and personal liability insurance representatives to find out whether their professional and personal liability insurance covers social networking sites. Psychotherapists should avoid using certain types of speech online, even if they use high privacy restrictions and other protections, such as pseudonyms. These communications might include breaches of client or supervisee confidentiality, speech that is potentially libelous and speech that denigrates the reputation of the field in which they practice.

And the greatest of these is "Therapists should develop online technological competence."